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9907-048 (SFD)I U) F_ U) 04 LU =) c) CY LL1 6 Z cc) 0 (0 W UJ EL U) Z C\1 0 C\J 0) < Q_ 2 Z LO 0 X LLJ 0 _J _J < < C) Cj o I:C Lo M 'j- Z ob 5 0 _J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. 6 License # Lic. Class Exp. Date Signature of Contractor Date' 1, )z ` M 17 , ' t� — �� VVJ I �v OWNER -BUILDER DECL-ARAT'ION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) * 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). I am exempt under Section _, B&P.C. for this reasorri--�� Date Signature of Owner,--- )A-\ ,A 1), 'WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ). I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. P, ldAl QW, CONIP WN976�, 56_17(;.1 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: — Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and Shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this applicatio , n is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject pjarmit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Si Date' -1 A, ,,pature (Owner/Age'ni) 74�<A I A PERMIT # BUILDING PERMIT 9%)7-048 DATE VALUATION 4*223,7., LOT TRACT .46�6(j )CI L4 L J 1 - I t�. ( r-.�e N JOB SITE I � V ADDRESS 79- 0200TRUS APN 769-670-037 OWNER CONTRACTOR / DESIGNER ENGINEER SUPFF0.1) HOMES SHE.12FIri.LD HOMES .1400 CXKCRAL AVO�UF STE 325 3400 CENTPLAL AVE'NUE, STE 325 WtVEASIDE CA 92-5045 RMUSWE' CA 97506 USE OF PERMIT -AMILY DWELLANQ i N 04, E F 8F0 - LOT 3 PLM iAR PERA&T'QOE�S NOT INCLUDE P CKX 09. BLOM WALL, )A C-ONSTRUCTIM ^,762.00 SF C MUM, vomalipKno, 284.00 SF 0ARA0U'CA1U>CAX3' 501.00 W U-STATATED C0119T OF CONSTIVUCTION 2 8; 7M. 0; 0 PERMIT FRE SUMAIARV' C 0 N STR. Ct C r 10 N YM,* 10t-000-419-0010 1101.00 P7, A W CNA TCK FT, R 10140-430�_118 S9910 NIRCHANICAL F1.7,111 PlXk,�MICAL FEE 101 -WO -420-000 $183.19 10.1-000-419-000 $1,81.7.5 WRONOMOT10'N Fr,�'.'-XESM 1014M-241-000 CIPUM.)INIC F11h 101-000-423-000 1NMANTRUCIVRE Fa-. 225-11ACH43-3,12 AWF (N PUSUC PLACES - RF00701-000-25,54M %_12.1.$9 rFF PFP031T 1011-00111-419-318 _$7S0.00 S'UTYRNAL COWSMUCTION ANDP!LAN 04fXX $7,86A.93 LESS PRE -PAID FEES 4750.00 T(Y.CAL MUMIT YEKS DUE NOW $7,110.93 1d3G DOW, NIZ) C i -2 J \ 19. 10E "... I , I RECEIPT DATE By DATE FINALED INSPECTOR INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade -7- Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T,O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam - Approval to Cover Equipment Location Underground Electric Underground PIbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 57'_ 7,<_ZZ7—� Water Piping Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster r Lateral ot 0 Pool Cover S�wer Connection Encapsulation Mas Piping Gas Test Z17 Appliances Final Final Utility Notice (Gas) 2-- /Y 101 1 /0,0Z ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring LowVoltageWidrig Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Gr COMMENTS: I-_4 -I- 4� CL oi-